Our goal is to provide the best Plastic Surgery Care care in the Hampton Roads region for people of all ages.
Your dermatology specialist will use the Mohs technique to remove your skin cancer. This is an office technique in which the skin is removed a layer at a time, processed, then examined under a microscope to ensure complete removal of the cancer. This process may take anywhere from one hour to half a day or longer for large skin cancers. After obtaining clear margins, a secure dressing will be applied, and you will be released.
Whether the defect created by the Mohs resection is large or small, Dr. Deutsch will surgically reconstruct the area to minimize scarring and provide the most natural appearance. The reconstruction is often done in the hospital under light sedation the day following your Mohs surgery; in some cases, reconstruction for smaller defects will be done in Dr. Deutsch’s office the same day as the Mohs resection. There are a variety of techniques Dr. Deutsch can use to reconstruct the wound left after the cancer is removed. Occasionally, the defect is small enough to be closed by bringing the exposed skin edges together. Another choice is a skin graft. A skin graft is a piece of skin taken from one area (such as the neck or in front of the ear) and placed into the exposed area.
Often the best option is a flap-- this technique involves rotating the skin immediately next to the defect into position to cover the exposed area. A flap typically provides the best color and contour match. For larger defects of the nose, a forehead flap may be used. This technique involves the transfer of skin from the upper forehead to the nose, and usually requires two stages. Dr. Deutsch is the premier surgeon for nasal flap reconstruction in the Tidewater area. His colleagues continually seek his expertise in this specialized type of surgery for their patients.
Hospital surgeries are done under light anesthesia and typically take one hour or so. You will be discharged the same day with instructions to clean the suture line with peroxide and apply antibiotic ointment three times per day. You will be given prescriptions for an antibiotic and pain medication. Dr. Deutsch will see you back one week after surgery to remove the sutures.
Why two surgeons?
Mohs surgery, done by only a few dermatology specialists in the area is the gold standard for removing skin cancers from areas where precision is crucial-- the nose, ears, eyelids and other facial regions.
Dr. Deutsch is a facial plastic surgeon with extensive experience in flap and graft reconstruction of facial skin cancer defects. These two specialists have worked together for years.
What is a facial plastic surgeon?
A facial plastic surgeon is a specialist who has a commitment to specifically treating conditions of the face, head and neck-- this is in contrast to a general plastic surgeon who treats the whole body. Most facial plastic surgeons have completed a four-year residency in otolaryngology (ENT)-head and neck surgery after medical school. This time is devoted to learning the complex anatomy of the head and neck and treating a variety of conditions specifically in this region. Some surgeons such as Dr. Deutsch choose to further their training by applying for and completing one of the coveted Facial Plastic and Reconstructive Surgery fellowships. This is an opportunity for the surgeon to further develop his/her skill in this area by working one-on-one with one of the master surgeons in the field.
How long is the healing process?
The early flap swelling usually settles in one week or so. The appearance of the flap continues to improve for 6-8 months after the surgery as the flap contracts to a smoother contour.
Will I have scars?
Any surgery will leave scars, but the reconstruction is designed to camouflage these as much as possible. You will use Vitamin E or silicone cream post-operatively to promote good scar healing.
Will I have additional procedures?
Minor revisions such as flap thinning or scar touch-ups may be desirable 3-4 months after surgery. These procedures are done in Dr. Deutsch’s office and usually require minimal down time.
Dr. Brian Deutsch is a facial plastic surgeon specializing in skin cancer reconstruction. He has been working with other Mohs dermatologists to provide precision removal of skin cancers and the highest quality reconstructions.